CDUS在脑梗死(CISS分型)中的应用价值

Application of CDUS in the Cerebral Infarction(Classified by Chinese Ischemic Stroke Subclassification)

目的分析脑梗死的发病危险因素,进一步了解CDUS在LAA的应用价值,从而合理优化LAA血管检查方案,为临床决策提供帮助。方法以头颈部CTA作为狭窄诊断标准筛选符合入选条件的LAA(CISS分型)患者共计90例。15例未发现颅内外血管狭窄,75人发现颅内外血管狭窄,异常率78.94%(75/90)。高血压及2型糖尿病是LAA发生血管狭窄的危险因素。记录狭窄相关数据,经统计学分析。与CTA比较CDUS检测颅外段血管狭窄可靠性一般,颈内动脉(Internal carotid artery,ICA)可靠性最高(Kappa值0.82),椎动脉(Vertebral artery,VA)一致性最差(Kappa值0.38);VAχ2检验P值0.008﹤0.05,有统计学差异,提示VA检查的一致性差;CDUS检测颅外段血管阴性符合率最高97.22%,其次为总体符合率91.55%。本组实验颅外动脉狭窄中以ICA颅外段狭窄最多51.11%(46/90),颅内动脉狭窄中以MCA颅内段狭窄最多37.16%(55/148)。结果与结论 (1)高血压、2型糖尿病为LAA发生狭窄的危险因素。(2)CDUS检测前循环病变优于后循环病变,对中、中重度狭窄检查效果优于轻度,颅外段ICA狭窄的比率最高,对VA检查效果差。

Objective analyze the risk of cerebral infarction on the basis of the results of CDUS, and to further understand the values of CDUS in the treatment of LAA（CISS） so as to rationally optimize the use of vascular examinations and treatments of cerebral infarction, and to help make clinical decision. Methods A total of 90 patients with LAA（as classified by CISS） were included based on the CTA of head and neck, of which 15 patients didn＇thave stenosis of intra and extracranial vessels, while 75 had, the rate of abnormality being 78.94%（75/90）. Hypertension and type II diabetes mellitus were the risk factors for the stenosis in patients with LAA. The data related to the stenosis were recorded and analyzed. CDUS was not so reliable as CTA in detecting extracranial stenosis, with the highest reliability in ICA assessment（Kappa 0.82）, and the poorest consistency in VA assessment（Kappa 0.38）; χ2 test for VA showed p value of 0.008, statically significant, suggesting the poor consistency of VA assessment; the assessment of extracranial vessels with CDUS showed the highest agreement level in negatives（97.22%）, followed by total results（91.55%）. In this study of the stenosed extracranial arteries, extracranial ICAs were the most（51.11%, 46/90）, and of the stenosed intracranial arteries, intracranial MCAs were the most（37.16%, 55/148）. Results and Conclusion（1） Hypertension and type II diabetes mellitus are the risk factors for the stenosis in patients with LAA.（2） CDUS is more reliable in the assessment of anterior circulation than posterior circulation, and is more reliable in the detection of moderate and severe stenosis than minor stenosis. The proportion of extracranial ICAs are the highest among the stenosed extracranial arteries. CDUS is not reliable in VA assessment.